Improving medical students

Archive for the ‘Residency’ Category

On the 80-hour Workweek Cap – Part 2

Posted by medliorator on March 14, 2009

Pauline W. Chen, M.D. :

I spoke with Dr. Thomas J. Nasca, the chief executive of the council, and asked him about resident duty hours

Q. What have been some of the effects of decreasing duty hours on patient safety?

A. We know there have been a lot of unintended consequences, some of which have not been good for patients. One of these unintended consequences, for example, has been an increased number of handoffs between doctors leaving their shift and new doctors coming on. The handoff period is the most vulnerable period for a patient, not because the people handing off data are not doing their best or because institutions don’t have systems in place. It’s a vulnerable period simply because one cannot predict what will happen when a patient is ill, and the doctors left caring for those patients don’t know them.

Another unintended consequence has been placing residents in certain ethical quandaries. One resident told me about caring for a child who was dying. She had taken care of this child for 10 or 12 days and was on call when it became clear that the child was going to die in the next few hours. But this resident was supposed to go home; her hours limit was up.

This resident stayed, but there was an unintended consequence. She could tell the truth about breaking the hours rule, and thus jeopardize herself and the residency program. Or she could lie.

On Young Doctors and Long Workdays [NYT]

Posted in Residency | 1 Comment »

On the 80-hour Workweek Cap – Part 1

Posted by medliorator on March 14, 2009

Pauline W. Chen, M.D. :

I finished my general surgery training in 1998, five years before the national accrediting organization for residency programs set a limit of 80 hours per workweek for residents across the country. I worked on average 110 to 120 hours per week and had my share of being on call every other night. Like many of my peers, I know about fatigue so overpowering that the odor from your pores smells not like nervousness or exertion but exhaustion. I have experienced the teeth-chattering chill of the early morning, which never leaves despite two layers of clothing, a sweatshirt and a doctor’s coat. I remember that falling asleep at 5 a.m. for an hour before rounds does more harm than good. And I can tell you that a quick but well-timed morning shower after being up all night is the physiological equivalent of a two-hour nap.

Does More Sleep Make for Better Doctors? [NYT]

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Residency Stress Rankings

Posted by medliorator on January 7, 2009

One medical student’s perspective:

  1. General Surgery
  2. OB/Gyn – there’s relatively less ‘control’ / predictability over how patients will do from what I’ve seen.
  3. Internal Medicine – again, just biased by what I see the residents go through
  4. Surgical Subspecialties – stressful to train, but I think it gets easier in the career itself.
  5. Emergency Medicine – while the career is good, I think the fact that these are ’emergencies’ is stress inducing on its own, plus who wants to do overnight shifts when they’re 60?

Most Stressful Medical Specialty? [Scrub Notes]

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Negative Reinforcement in Residency

Posted by medliorator on November 15, 2008

At the core of every doctor’s training is the internship, that first year of residency that begins just a few weeks after all the pomp and circumstance and lighthearted celebration of medical school graduation. Sometimes referred to as simply the first year of residency, internship is the first step in a professional journey

Negative reinforcement during those early years taught me to be a cautious and conscientious doctor. Our teachers rarely praised us for good work and never allowed us to forget our errors. But sometimes the lessons had little to do with learning how to care for patients.

“People have a natural desire to do good, physicians especially,” she said. “But the problem,” she continued, “may be a training system that encourages not how I can improve but how I can survive.”

A Positive Approach to Doctors-in-Training [NYT]

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The Most Important Components of your Residency Application

Posted by medliorator on October 26, 2008

METHODS: A questionnaire consisting of 20 items based on the current Electronic Residency Application Service (ERAS) guidelines was mailed to the program directors of all 118 EM residencies in existence in February 1998. The program directors were instructed to rank each item on a five-point scale (5 = most important, 1 = least important) as to its importance in the selection of residents.

RESULTS: Response rate = 79.7% of Emergency Medicine residencies

Rank Application Parameter Rank (+/- SD)
1. Personal Statement 2.75 (0.96)
2. Publications 2.87 (0.99)
3. Basic Science Grades 2.88 (0.93)
4. Extracurricular Activities 2.99 (0.87)
5. Medical School Attended 3.00 (0.85)
6. AOA Status 3.01 (1.09)
7. Awards/Achievements 3.16 (0.88 )
8. USMLE step I 3.28 (0.86)
9. Interest Expressed in Institution 3.30 (1.19)
10. USMLE Step II 3.34 (0.93)
11. Elective Done at Institution 3.75 (1.25)
12. Recommendations 4.11 (0.85)
13. Clinical Grades 4.36 (0.70)
14. Interview 4.62 (0.63)
15. EM rotation grade 4.79 (0.50)

Selection criteria for emergency medicine residency applicants [Acad Emerg Med. 2000 Jan;7(1):54-60.]

Correlate: The Most Important Components of your Residency Application – Part II

Posted in Matching, Residency | 1 Comment »

Residency Specialty & Average USMLE Step 1 Score

Posted by medliorator on October 21, 2008

Overall, U.S. senior applicants in 2007 had mean USMLE Step 1 scores of 220.4 (s.d. = 20.3)

For U.S. seniors who matched in 2007:

Rank Specialty Average Step 1 Score
1. Plastic Surgery 243
2. Dermatology 240
3. Otolaryngology 239
4. Radiation Oncology 236
5. Radiology – Diagnostic 235
6. Orthopaedic Surgery 234
7. Transitional Year 233
8. Internal Medicine 222
8. Pathology 222
8. General Surgery 222
11. Emergency Medicine 221
11. Internal Medicine / Pediatrics 221
13. Anesthesiology 220
14. Neurology 218
15. Pediatrics 217

Charting Outcomes in the Match [NRMP]

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How to Make Clinical Decisions and Avoid Defensive Medicine

Posted by medliorator on August 29, 2008

I was asked to examine a patient who was scheduled for an emergency amputation of her leg because of gangrene. I went over her chart and discovered that one of the junior residents had seen her the night before and had requested two consults… I cancelled the consults because they were unnecessary.

The next day, I ran into the resident who requested the consults… I asked him why he asked for the consults. His reply made me see red. It is the reply of the imbecile, of the doctor who is afraid to think and make decisions, and it drives me to distraction: “To spread around the responsibility”. To be fair, it is not all his fault, he learned this “defensive medicine” posture from [the chief of anesthesiology].

I told him that even if he really believes in that philosophy, he should never actually say it out loud, it’s just plain embarrassing. I proceeded to impart two pearls of wisdom that I believe are universal:

  1. If you ask the consultant a stupid question, you will, invariably, get a stupid answer. Don’t just ask for a “cardiology consult”. One must ask the consult a specific (and hopefully intelligent) question. For example, “Does this patient need further workup and/or intervention for her chest pain?”
  2. You better have a damn good justification for delaying surgery if the delay endangers the patient. In this case, delaying the amputation exposed the patient to another day of infection that could have developed into full blown sepsis with septic shock… Had such a complication occurred, the first question the judge will ask is: “What did you gain from the consults that justified delaying surgery and endangering the patient”.

I believe in this guiding principle: Any investigation, whether a consultation or a blood test should be done only if the results will affect patient management. Not only is an unnecessary test a waste of money, it may even endanger the patient.

Unnecessary Tests [The Sandman]

Posted in Clinical Rotations, How-To, Medical Ethics, Professionalism, Residency | Comments Off on How to Make Clinical Decisions and Avoid Defensive Medicine

Gender in Surgical Demographics

Posted by medliorator on August 20, 2008

Women now account for more than 50% of American medical students, but only 10% of neurosurgery residents.

part of the reason more women aren’t going into neurosurgery is because there aren’t more women in the field to serve as mentors and role models. Women account for less than 6% of the neurosurgery ranks.

Women Remain Scarce in Neurosurgery [wSJ Health Blog]

Posted in Neuro, News, Residency, Surgery | 1 Comment »

Building a Successful Resume for Residency

Posted by medliorator on July 16, 2008

the page should have more blank space than text. Wall-to-wall print is overwhelming and difficult to read. If you have a lot of accomplishments, that’s great. But be sure that the ones you are trying to highlight are not lost in a big list. Don’t include anything on your CV that you would not want to become the main focus of an interview.

In most cases, CVs are now submitted online through the Electronic Residency Application Service (ERAS). This means that you must format your CV within the confines of the ERAS format. You can familiarize yourself with this format by using the MyERAS Application Worksheet

The ERAS application is divided into these categories: Education, Experience (Work, Research, or Volunteer), Publications, Languages, Hobbies and Interests, Awards, Accomplishments, and Memberships in Honorary or Professional Societies. Developing experiences within each of these categories will help you produce a successful CV.

How Can I Develop a Good CV for Residency? [Medscape]

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Residency: 56 Hour Work Week?

Posted by medliorator on June 27, 2008

Rumor has it that resident work hours will be shortened to 56-hours per week. How to make up the experience? Add a year to residency of course. [Kevin MD]

see Committee on Optimizing Graduate Medical Trainee (Resident) Hours and Work Schedules

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